PrintImprimer Dietitians' challenges in this pandemic unfolded over time, in unique circumstances, in different practice environments, and with diverse client populations. While individual circumstances vary depending on the practice setting and type, dietitians have a professional obligation to provide safe, ethical, and competent services to every client/patient in their care. Some dietitians have identified situations that can impact client-centred services in their dietetic practice (e.g., heavy workloads, reduced thoroughness of record-keeping). In these circumstances, dietitians can proactively examine their practice and take a solution-focused approach to foster client-centred values, behaviours, processes, and quality practice.

How can dietitians keep up with quality practice in demanding times?

Here are some helpful suggestions on building individual capacity and capacity in the healthcare team to keep up with quality, client-centred care.

1. Practising More Efficiently

To improve practice efficiency, you may want to examine your practice for improvements:

• Evaluate current work routines and determine whether your workflow can improve and increase productivity.
• Appraise your record-keeping process. Strive to produce precise, complete, accurate and timely documentation in a client's health record. The Professional Practice Standard: Record Keeping for Registered Dietitians in Ontario sets the minimum expectations.
• Look for ways to build capacity to maintain thorough assessment, intervention, follow-up, and record-keeping to ensure client safety. Identifying & Managing Problems in the RD Work Environments provides some guidelines.
• Build your resilience to practise more effectively by using solution-focused thinking, setting limits, and realistic optimism. This article on Resilience and Managing Risks explores resilience strategies for managing risks in dietetics practice in Ontario.

2. Ranking Client Priority

Create or adopt a screening tool to rank client priority on nutrition risk and other indicators important to your practice setting:

• When demand is high, have a clear policy for prioritizing care in your private practice of sharing the caseload between dietitians or other healthcare professionals.
• Your responsibilities as a dietitian do not change when you are faced with workload pressures or staffing demands. Act in the best interest of each client in your care.
• Use professional judgment and consider the client's best interest to determine when to provide care in-person vs. virtually. Consider client preference and context to determine when to provide in-person or virtual care, such as client needs (e.g., age, language and communication barriers), access and the presenting condition.
• If virtual care is provided, it must meet the same standard of practice as would apply in-person. Please access guidance on virtual care here.

 3. Referring Clients Appropriately

Educate other healthcare professionals on appropriate dietitian referrals:

• Consider developing a referral tool and booking procedure to enable clear triaging of clients and relevant referral pathways.
• Review with colleagues your referral/triaging policy for shared understanding and use when referring clients.
• Set clear expectations to build team collaboration. For example, the Collaborative Care Professional Practice Guidelines for Registered Dietitians in Ontario provide best practice suggestions when collaborating within the healthcare setting.
• Assume responsibility and accountability in the provision of responsive and timely dietetic services.

4. Developing Skillful Communications

Focus on the quality, not the quantity, of time spent with your clients.

• Communication is an essential dietetic practice competency for dietitians in Canada.
• Be mindful that the effective communicator is guided by awareness of not taking others for granted or allowing stereotyping to get in the way of communicating.
• Skillful communication leads to better health outcomes and more satisfied clients. This CDO article provides guidance: How do you know you are communicating well?
• Work to develop a client-centred participatory decision-making communication style when interacting with clients.

 5. Engaging Clients

Clients who are more engaged in their health care do better:

• Engagement supports client-centred care. Before a first visit, providing clients with information or tools, such as an FAQ sheet or a food diary, may promote engagement.
• Obtain informed consent before providing services and consider clients' best interests by respecting their right to make their own decisions.
• Assume responsibility to facilitate client-centred learning and informed decision-making by focusing on client needs and goals. Make sure clients understand the options presented and consider their perspectives and values when making decisions.
• Show respect for individuals, autonomy, and rights regardless of race, religious beliefs, colour, gender, physical and/or mental disability, marital status, family status, economic status, education level, age, or sexual orientation. This article, From the Client's Perspective, provides some guidance.

 6. Focus on quality improvements

The Institute of Medicine (2015) outlines these quality goals for the health care system¹:

• Avoiding harm to clients/patients from the care intended to help them.
• Providing services based on scientific knowledge to all who could use them and refraining from providing services to those not likely to benefit from them (avoiding underuse and misuse, respectively).
• Providing care respectful of and responsive to individual client/patient preferences, needs, and values and ensuring that client/patient values guide all clinical decisions.
• Reducing waits and sometimes harmful delays for those receiving and giving care.
• Avoiding waste, including waste of equipment, supplies, ideas, and energy.
• Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, socioeconomic status and more.

 7. Seek Support

Different people respond to situations differently. There is no right or wrong way to cope with stress and maintain wellness. Sometimes, when we feel concerned and overwhelmed, reaching out to social supports, the College’s practice advisors, and others can be helpful.

• Work with your employer to help improve your situation and address underlying issues. Organizations often have resources, policies, protocols, or risk-management strategies available.
• Refer to supportive networks, trusted mentors, or interprofessional team members (as applicable) for guidance and support.
• If stress affects your health, seek counselling or advice from an appropriate health professional.
• The College is here for dietitians as they navigate these practice challenges. We encourage dietitians to contact us for any assistance they may need at practiceadvisor@collegeofdietitians.org, 416-598-1725 / 1-800-668- 4990, ext. 397. We are here to listen, empathize, and provide the best guidance possible. We appreciate hearing from you!

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Footnotes

1. Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001.
2. Cruess, S. R., Johnston, S., & Cruess, R. L. (2004). "Profession": A working definition for medical educators. Teaching and Learning Medicine, 16(1), 74–76.
3. Dugdale, L. S., Siegler, M., & Rubin, D. T. (2008). Medical professionalism and the doctor-patient relationship. Perspectives in Biology and Medicine, 51(4), 547–553.

Resources

Institute of Medicine (IOM). Performance Measurement: Accelerating Improvement. Washington, D.C: National Academy Press; 2005.
Hibbard JH, Pawlson LG. Why Not Give Consumers a Framework for Understanding Quality? Joint Commission Journal on Quality Improvement 2004 June. 30(6); 347-351.
World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. Geneva: Author. Retrieved from http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf

The College has also developed several resources to assist dietitians and others in enhancing IPC within their professional practice. Refer to the following resources:

• Enhancing Interprofessional Collaboration
• Effective Use of Knowledge in Interprofessional Teams
• Interprofessional Collaboration e-learning module: Interprofessional Collaboration Addressing Conflicts Between Health Care Professionals